Allen Frances has a considerable reputation in psychiatry as one of the main architects of DSM-IV and one of the main critics of DSM-5, and especially some of the proposals for early drafts of DSM-5. He has an active Twitter feed, he used to write a blog for Psychology Today, and he also posted regularly for Psychiatric Times. In his new book he writes about the political crisis facing the USA with the terrible policies proposed by the White House and the incompetent leadership of the President. Frances writes at length of the many problems facing the world today and the ways in which the current political situation will just make things worse. He focuses on climate change, the growth in the world's population, the limited resources available in the world, the problems of poverty, and problems of health care. He analyses the situation both in the USA and the rest of the globe. He tries to explain why Trump was appealing to a significant number of voters, and he gives proposals for how to win them over to a more rational understanding of the world.

Frances dispenses with the issue of Trump's mental health quickly at the start. In order to count as mentally ill, your life has to be going badly -- the condition needs to be causing problems in your life. But since Trump has been successful in his professional life and he shows no major problems in his family and personal life, he is not mentally ill. Frances was one of the creators of the diagnostic criteria for narcissistic personality disorder, and he is clear that Trump does not have this disorder. But Frances is equally clear that Trump is indeed narcissistic and lacks the ability to pay sustained attention to anything in depth. He warns against any attempt to impeach Trump, however, because the people next in line to take power have less problems with their personalities but even worse ideas for policy.

In analyzing the appeal of Trump to voters, Frances warns against dismissing them as stupid. He points out that they have legitimate concerns about their jobs and quality of life, and says that they were inclined to believe Trump's promises that he would improve their lives. However, Frances' approach here does not take us very far, because he is still very straightforward in his verdict that Trump's promises were completely without foundation, and that he is in fact out to help the rich, not the middle classes. The only possible conclusion is that anyone who believed Trump's promises about helping those who live in areas that have terrible job prospect must still be stupid. At various points in the book he says that there is a collective madness of society in being willing to believe Trump's claims about the world, but he doesn't get very far in saying what this might be other than brainwashing by Fox News.

Frances is largely pessimistic about the future of the world, giving many examples of how bad are the policies enacted by governments and influential groups all over the world. But he does hold out some hope that with the right sorts of thoughtful analysis and grass roots action, we can move in a better direction. He gives a number of examples of how there have been productive social changes through political action: he is especially inspired by the movements towards a less materialistic approach to life and efforts to make the world more fair, reducing discrimination in how society treats different groups of people.

At one point in the book, Frances wonders how supporters of Trump would react to his ideas. But it's hard to imagine that any Trump supporters will ever read Twilight of American Sanity. He is almost certainly preaching to the converted. While the points he makes are nearly all sensible and well defended, it is a hard book to read from beginning to end. It is relentless in criticisms of Trump and the policies that have emerged from the White House, and that have been supported by the Republican Party for years. For any follower of politics, the issues will be familiar and it rare for Frances to shed new light on the problems he is analyzing. It is good to have them all collected in one book, and his focus on the most pressing problems facing the future of the world does help to sharpen the debate. But I can hardly imagine many readers with a comprehensive political knowledge really wanting to read all through this book. It would be more useful to young people and political novices who are still looking to learn about some of the basic issues facing the world today.

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